Admission cardiotocography: A hospital based validation study

Abstract

Objective: Admission CTG is a short fetal heart rate (FHR) tracing recorded immediately at hospital admission to avoid unnecessary delay in action among pregnancies complicated by pre-existent fetal distress. There are different opinions regarding the value of the admission CTG, especially in low risk pregnancies.

Study design: A retrospective validation study from Karolinska University Hospital, Jan 2011 to June 2015 (total number of deliveries = 40,061). All women who underwent emergency cesarean section within one hour of admittance due to suspected fetal distress were identified. We assessed whether an admission CTG was performed, if it was beneficial for the decision to perform emergent cesarean delivery and if there were objective signs of fetal compromise or if it was performed unnecessarily. The main outcome was the benefit of the admission CTG in the decision to perform emergency cesarean delivery.

Results: Eighty-eight cases (0.22%) fulfilled our inclusion criteria. Over 90% of these women (80/88) had objective evidence of compromised fetal well-being, i.e., indicating that emergent delivery was necessary. In 74% (54/73) of all cases was admission CTG determined to have been beneficial in the decision to perform cesarean delivery, equally effective of those classified as low- and high risk pregnancies before admission. In 28% (15/54) the CTG pathology was deemed difficult to identify by auscultation.

Conclusion: Admission CTG was deemed beneficial in 74% of both low- and high-risk pregnancies that were delivered by emergent cesarean section within one hour of admittance due to suspected fetal distress.

Keywords: Asphyxia; CTG; Cesarean; Midwifery; Morbidity; Mortality; Severe outcome; Validation.